Presentation on theme: "Welcome to the Mount Sinai PPS Town Hall April 23, 2015 9:30 a.m. to 10:30 a.m."— Presentation transcript:
Welcome to the Mount Sinai PPS Town Hall April 23, 2015 9:30 a.m. to 10:30 a.m.
Town Hall Agenda 1.Follow-up from Last Town Hall 2.Questions and Answers 3.State and PPS Updates: 1.Timeline 2.Achievement Values 3.Partner Agreement 4.Value-Based Payment Roadmap 4.Questions and Answers 5.Closing
Follow-up from Last Town Hall Ha Nguyen April 23, 2015
Is it possible for a provider to switch from one project to another? If so, how does the provider do that? Mount Sinai4 Providers may switch projects by First, advising current project leads and consultants of their desire to switch projects. Second, connecting with the project leads and consultants of the new project they wish to join to ensure it is a good fit. Phase Two Participation Agreements will clarify partners’ roles and responsibilities in any current project(s) they are participating in.
How does the DSRIP program define safety net versus non-safety providers? Mount Sinai5 Providers qualify as safety net providers because their services to Medicaid and uninsured individuals represent more than 35 percent of their total volume of Medicaid reimbursable services. These providers are approved to be selected by the state as safety net providers upon implementation of programs that allow Medicaid reimbursement of 1915(i) services under the state plan and the 1115 demonstration. http://www.health.ny.gov/health_care/medicaid/redesign/dsrip /safety_net_definition.htm
How will funds flow to safety net providers versus non-safety net providers? Mount Sinai6 Each Project Plan receives a maximum monetary valuation during application process. Under state regulations, providers that do not meet the DSRIP eligible safety-net provider definition may only receive, in aggregate, 5% of the performance payments from a project’s total valuation. The remaining 95% of the performance payment may be made to the safety-net qualified PPS providers.
How do I find out if my organization meets the DSRIP safety-net qualifications? 7 A list of DSRIP eligible safety-net providers is available on the DSRIP website. If a provider sees “True” listed in the “final results” column, then the provider has passed at least one of the eligibility tests and has qualified to be a DSRIP safety-net provider. The DSRIP safety-net list website can be viewed at: http://www.health.ny.gov/health_care/medicaid/red esign/dsrip_safety_net_definiti on.htm http://www.health.ny.gov/health_care/medicaid/red esign/dsrip_safety_net_definiti on.htm
What happens to partners who want to be removed from the PPS? Can you remove partners after finalizing your partner list? Mount Sinai8 Once PPS networks submitted for final attribution in December 1, 2014, the PPS cannot remove any partner until Year 3 (DSRIP Mid-Point Assessment) in 2017. PPSs may submit proposed modifications for state and CMS review, including removing PPS partners at DY3. These Project Plan modifications may not decrease the scope of the project unless they also propose to decrease the project’s valuation. Removal of a lower-performing PPS member organization requires a proposed modification and must follow the required governance procedures, including progressive sanction requirements.
What are the DSRIP Clinical Performance Measures? Mount Sinai9 Each project has a number of Clinical Performance Measures, which will be monitored against in a Pay for Reporting (P4R) and Pay for Performance (P4P) manner. Below are the sources of the measures: HEDIS 2014 and 2015: http://www.ncqa.org/Portals/0/HEDISQM/Hedis2015/List_of_HEDIS_2015_Measures.pdf Consumer Assessment of Healthcare Providers and Systems (CAHPS) : https://cahps.ahrq.gov/about- cahps/index.html 3M Health Data Dictionary Agency for Healthcare Research and Quality (AHRQ 4.4): http://www.qualityindicators.ahrq.gov/Default.aspx http://www.qualityindicators.ahrq.gov/Default.aspx Quality Assurance Reporting Requirements (QARR) http://www.health.ny.gov/health_care/managed_care/qarrfull/qarr_2013/docs/qarr_specifications_manu al_2013 http://www.health.ny.gov/health_care/managed_care/qarrfull/qarr_2013/docs/qarr_specifications_manu al_2013 Health Resources and Services Administration (HRSA) http://www.hrsa.gov/data-statistics/index.html The Joint Commission http://www.jointcommission.org/performance_measurement.aspx Other
What are the DSRIP Clinical Performance Measures? Mount Sinai10 This document contains the clinical performance measures each project will be measured against: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/dsrip_specif_report_manual.pdf
State Update: Implementation Plan Submission PPSs will be required to submit their initial Implementation Plans for IA review by June 1, 2015 The June 1 submission must include: All Organizational Components including Governance, Financial Sustainability, Cultural Competency and Health Literacy Initial projections for all 3 Workforce Milestones – Workforce Budget, Workforce Impact, and Workforce New Hires Project 2.a.i Patient Engagement Speed for all applicable projects The June 1 submission WILL NOT include: Provider Speed & Scale ramp ups (eliminated entirely) Major risks to implementation and mitigation strategies (included in July submission) 14
▶ For all projects, exclusive of Project 2.a.i, PPSs will be required to submit Implementation Plans July 31, 2015 – Provider Speed & Scale is no longer a submission requirement – Project Implementation Plan will include Major risks to implementation, mitigation strategies, and interim steps to achieve the project requirement milestones by the required completion dates ▶ PPSs will be required to identify the network providers that will be participating in each project as part of the October quarterly reporting process (due October 31, 2015) – There will be NO Provider Speed & Scale ramp up required State Update: Implementation Plan Submission
Reporting and Payment Schedule 16 ▶ There are 4 Reporting Periods per DSRIP Year and 2 semi-annual Payment Periods per DSRIP Year (DY1 and DY2 illustrated below) – DY3 – DY5 will follow timelines like that of DY2 DSRIP Year/Quarter Dates CoveredQuarterly Report DuePayment Date DY1, Q1April 1, 2015 – June 30, 2015July 31, 2015January 2016 DY1, Q2July 1, 2015 – September 30, 2015October 31, 2015 DY1, Q3October 1, 2015 – December 31, 2015January 31, 2016July 2016 DY1, Q4January 1, 2016 – March 31, 2016April 30, 2016 DY2, Q1April 1, 2016 – June 30, 2016July 31, 2016January 2017 DY2, Q2July 1, 2016 – September 30, 2016October 31, 2016 DY2, Q3October 1, 2016 – December 31, 2016January 31, 2017July 2017 DY2, Q4January 1, 2017 – March 31, 2017April 30, 2017
Partner Participation Agreements ▶ Phase 1 – Broadly specifies the roles and responsibilities of being a partner in the MS PPS network, outlining expectations of partners in areas such as data sharing, credentialing, and liability insurance. – Revised agreement distributed on 3/23 – 87% of partner agreements received – 35 Partners remaining out of 260 ▶ Phase 2 – Specifies details regarding partner participation per project, applicable metrics and milestones, roles and responsibilities as well as funds flow related to meeting performance metrics. – Draft Agreement to be distributed by end of June 2015 for review by PPS and Finalized by July-August, 2015. 19
What is the Value Based Payment Roadmap? ▶ Value Based Payment (VBP) Models are the mechanism by which the State plans to reinvest savings accrued through DSRIP ▶ The VBP Roadmap is a multi-year plan for comprehensive State Medicaid payment reform – New Roadmap Issued – v. 4 on April 8, 2015 – Provides a menu of options that plans and providers can choose from – Expect v. 5 sometime over the next month 21
What are the options? ▶ A provider and MCO can agree to share risk for the following types of Integrated Care: – Integrated Primary Care – Care Bundles: Acute care bundles (ie: maternity care, stroke) Chronic care bundles (ie: hemophilia, chronic kidney disease) – Total Care for a Subpopulation (ie: AIDS/HIV, DD) – Total Care for All Populations ▶ FFS payments can be used for: – Preventive and other services not conducive to VBP – Payments to downstream providers as part of Level 1 VBP arrangements 22
Value Based Payment Roadmap 23 OptionsLevel 0 Level 1 VBP: Shared Savings Level 2 VBP: Performance Risk Level 3 VBP: Capitation All care for total population FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings when outcome scores are sufficient FFS with risk sharing (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) Global capitation (with outcome-based component) Integrated Primary Care FFS (plus PMPM subsidy) with bonus and/or withhold based on quality scores FFS (plus PMPM subsidy) with upside-only shared savings based on total cost of care (savings available when outcome scores are sufficient) FFS (plus PMPM subsidy) with risk sharing based on total cost of care (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) PMPM Capitated Payment for Primary Care Services (with outcome-based component) Acute and Chronic Bundles FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings based on bundle of care (savings available when outcome scores are sufficient) FFS with risk sharing based on bundle of care (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) Prospective Bundled Payment (with outcome-based component) Total care for subpopulation FFS with bonus and/or withhold based on quality scores FFS with upside-only shared savings based on subpopulation capitation (savings available when outcome scores are sufficient) FFS with risk sharing based on subpopulation capitation (upside available when outcome scores are sufficient; downside is reduced when outcomes scores are high) PMPM Capitated Payment for total care for subpopulation (with outcome-based component)
What are the VBP Goals? ▶ By DSRIP Year 5, 80-90% of Medicaid MCO payments tied to Level 1 VBP or higher – Aspirational goal of 50-70% in Level 2 VBP or higher ▶ Adoption will be incentivized by additional MCO premium bonuses – Pass through to providers – Subject to negotiation with plans – Bonus based on type of VBP and total dollars at risk 24
Value Based Payment Timeline 25 ▶ Aligns with DSRIP Timeline
Provider Readiness 26 ▶ The State recognizes that there are varying levels of provider readiness, which are : – Leading (ready) – Learning (need time and tech. assistance) – Financially Challenged (IAAF and others that need to restructure before VBP) ▶ For those who are ready, DOH has an “Innovator Program”: – Greater incentives for early adopters that pursue high-risk VBP – Providers get up to 95% of the dollars paid by the state to the MCO – Plans not be responsible for covering losses incurred by providers ▶ Roadmap may allow limited exclusions for certain services or providers for which VBP arrangements are not applicable or appropriate. More details are forthcoming in 2015.
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